COMPARISON OF C MAC C BLADE AND D BLADE VIDEO LARYNGOSCOPES FOR ENDOTRACHEAL INTUBATION IN ADULTS WITH CERVICAL SPINE PATHOLOGY UNDER MANUAL IN LINE STABILISATION: A RANDOMISED CONTROLLED STUDY

Abstract

Background and aims; Cervical spine pathology poses major challenges for airway management, and manual in‑line stabilisation (MILS) can worsen laryngoscopic view and intubation conditions. The C‑MAC video laryngoscope is available with a conventional Macintosh‑type C‑blade and a hyper angulated D‑blade, but comparative data in patients with cervical spine disease are limited. This study compared the ease of endotracheal intubation using the C‑blade and D‑blade of the C‑MAC video laryngoscope in adults undergoing elective cervical spine surgery under MILS.

Methods; In this single‑blinded randomised controlled study, 60 ASA I–II adults scheduled for elective cervical spine surgery and requiring endotracheal intubation were enrolled. After standardised anaesthesia induction and application of MILS, patients were randomised to intubation with either the C‑blade (Group C, n=30) or D‑blade (Group D, n=30) of the C‑MAC video laryngoscope, performed by an experienced anaesthesiologist. The primary outcome was time to successful intubation, defined as the interval from blade insertion at the lips to confirmation of tracheal placement by capnography. Secondary outcomes included time to best glottic view (best Cormack–Lehane grade), number of intubation attempts, use of external laryngeal pressure or bougie, haemodynamic responses, and complications.

Results;Demographic and airway characteristics, including age, sex, and Mallampati class, were comparable between the groups, although body mass index was higher in Group C. Mean time to intubation was similar with the C‑blade and D‑blade (42.57 ± 20.39 s vs 47.00 ± 14.29 s; P=0.2665). Time to best glottic view was significantly shorter with the D‑blade compared with the C‑blade (13.73 ± 3.19 s vs 15.57 ± 3.45 s; P=0.03). First‑attempt success was achieved in 100% of patients in Group D and 96.7% in Group C, and overall Cormack–Lehane grades and subjective ease of intubation were comparable. External laryngeal pressure was required in 86.7% of C‑blade intubations and in none with the D‑blade (P<0.001), while the need for bougie and the low incidence of minor complications did not differ significantly. Haemodynamic variables and oxygen saturation remained comparable between groups at all time points.

Conclusion;In adults with cervical spine pathology undergoing surgery under MILS, the D‑blade C‑MAC video laryngoscope achieved faster optimal glottic visualisation and markedly reduced the need for external laryngeal pressure compared with the C‑blade, while overall intubation time, success rate, and complication profile remained similar. Both blades appear suitable for use in this population, and selection may be guided by operator familiarity and specific airway characteristics.